Royal Rangers Registration

- Step 1 of 3

Child's Name *

First

Last

Parent/Legal Guardian's Name *

First

Last

Email *

Cell Phone *

Address *

Address Line 1

Address Line 2

City

New JerseyAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

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Child's Birth Date *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Child's Age *

Child's Current Grade *

Does your child have any food allergies? *

• Yes
• No

Please list all food allergies here: *

Does your child have any physical limitations or special needs? *

• Yes
• No

Please tell us what physical limitations your child has or what their special needs are? *

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On occasion, Crossroads Worship Center takes photographs or makes an audio or video recording of children and/or adults involved in activities. Such Photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio-visual recordings may be used in other publications or posts such as Facebook. *

• I give Crossroads Worship Center permission to use my child's image as stated above.
• I do not give Crossroads Worship Center permission to use my child's image as stated above.

By my signature below I testify that I am the legal Parent, or legal Guardian, and consent to my child's participation in the Royal Rangers and it's varied events (activities would include, but not be restricted to bus rides to and from activities, rallies, field trips, camp outs, pool parties, ball games, and any other normal activities on or off church campus) throughout the entire 2023-2024 year at Crossroads Worship Center located at 190 Lambs Rd, Sewell NJ. I also hereby release and forever hold harmless Crossroads Worship Center, its staff, leaders and agents from any and all liability resulting from injury, illness, loss or damage which may occur to my child while using the facilities or participating in Crossroads Worship Center's activities. *

Clear Signature

Signature

There is a $15.00 Royal Ranger charter fee for each boy (includes PayPal fees), your child cannot be registered without payment of the charter fee. Please note that there may be other fees associated with your child's club beyond the charter fee (i.e. supplies, t-shirts, etc.) and your child's commander will inform you if these fees are necessary. *

• Yes, I am ready to pay the $14.00 charter fee and complete my child's registration.

Total

$ 0.00

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